Subtyping children and adolescents who are overweight based on eating pathology and psychopathology

Children and adolescents who are overweight can differ on dimensions measuring dietary restraint and psychopathology. Classifying clinical obese children and adolescents based on these psychological characteristics is shown to be useful in making differential prognoses. The present study aimed to research the validity of subtyping children and adolescents with overweight (N?=?138) in a non-clinical sample. Using cluster analysis, results revealed three subtypes: a dietary restraint/internalizing group (DR?+?IN; n?=?41), a pure internalizing group (IN; n?=?20) and a non-symptomatic group (NS; n?=?77). The DR?+?IN group outscored both other groups on measures of eating pathology, whereas the IN group outscored both other groups on measures of negative offect. Interestingly, the three groups did not differ on degree of overweight. The results seem to suggest that different psychological mechanisms can be observed in subgroups of young overweight adolescents. Further research should explore how individual psychological characteristics can be helpful when stipulating weight loss treatment programmes.     

Testing a self‐determination theory‐based teaching style intervention in the exercise domain

Drawing from self‐determination theory (SDT), this study examined the effect of an autonomy supportive, well structured and interpersonally involving teaching style on exercise class participants' psychological need satisfaction, motivational regulations, exercise behaviour, behavioural intention and affect. Female exercise class participants enrolled in a 10‐week exercise program were exposed to an SDT‐based (i.e. SDTc; n = 25) or typical (i.e. control group; n = 31) teaching style. The control condition reported a significant decrease in autonomy support, amotivation and behavioural intention over time. In addition, they reported a significant increase in competence and introjected regulation. Compared to the control condition, the SDTc reported a significantly greater linear increase in structure and interpersonal involvement, relatedness and competence need satisfaction and positive affect. Attendance rates were significantly higher in the SDTc. SDT‐based social‐contextual characteristics and psychological needs predicted autonomous regulations; all these variables collectively predicted adaptive outcomes. Copyright © 2007 John Wiley & Sons, Ltd.     

Motivational characteristics of obese adolescents toward physical activity: Contribution of self-determination theory

IntroductionRegular physical activity (PA) practice represents a key component of obesity treatment.ObjectiveBased on self-determination theory (SDT), this cross-sectional study aimed to explore the motivational characteristics associated with PA practice among obese adolescents.MethodOne hundred and five overweight or obese adolescents (mean age = 15 years old, SD = 2.69) were questioned about their level of PA, motivational regulations toward PA and level of satisfaction of basic psychological needs.ResultsData revealed that satisfaction of autonomy and relatedness needs is positively associated with autonomous forms of motivation (e.g., for integrated regulation β = .44; and 0.35, respectively, p < .01). Otherwise, non-satisfaction of the needs of autonomy and competence is associated with the most controlled forms of motivation (e.g., for external regulation β = −.27, p < .01; and −.18, p < .05, respectively). In turn, a high level of identified regulation, a low level of external regulation and a high level of satisfaction of the need for competence are associated with weekly PA (β = .28; −.19 and .24, respectively, p < .05).ConclusionSDT appears as an interesting theoretical framework to explore motivational antecedents of PA among obese adolescents.     

The relationship between perceived autonomy support,exercise regulations and behavioral intentions in women

Objectives: To examine Self-Determination Theory’s (SDT; Deci, E.L., & Ryan, R.M. (1985). Intrinsic motivation and self-determination in human behavior. New York, NY: Plenum Press) proposition that perceptions of autonomy support underpin different regulations that, in turn, predict behavioral intentions in the context of exercise. The specific hypothesis examined in this study was that greater perceptions of autonomy support will be positively associated with more autonomous exercise regulations, which subsequently, will predict greater intentions to continue with exercise for the next 4 months.Design: Cross-sectional survey.Methods: Females (n=232) involved in a team-based intramural event sponsored by a large university completed a self-administered survey in small groups not exceeding 15 people. Participants ranged in age from 17 to 31 (M, 20.86 years; SD, 2.21) and reported healthy body mass index (BMI) values (M, 22.14 Kg/m²; SD, 2.33 Kg/m²).Results: Bivariate correlations indicated that perceived autonomy support from friends was more favorably associated with identified and intrinsic regulations, an ordered pattern of relationships was evident among exercise regulations, and autonomous (identified and intrinsic) exercise regulations were more strongly correlated with greater intentions to exercise. Multivariate analysis using structural equation modeling supported a motivational model based on tenets of SDT that accounted for a substantial portion of the variance in identified (R²=0.32) and intrinsic (R²=0.33) exercise regulations and behavioral intentions (R²=0.49).Conclusion: The motivational model proposed by SDT provides theoretically sound insights into the reasons why people intend to continue with exercise behavior, and allows for a meaningful analysis of motivational processes operating in the exercise domain.     

Cognitive-behavioral therapy plus motivational interviewing improves outcome for pediatric obsessive-compulsive disorder: A preliminary study

Abstract

Lack of motivation may negatively impact cognitive behavioral therapy (CBT) response for pediatric patients with obsessive–compulsive disorder (OCD). Motivational interviewing is a method for interacting with patients in order to decrease their ambivalence and support their self-efficacy in their efforts at behavior change. The authors present a preliminary randomized trial (N = 16) to evaluate the effectiveness of adding motivational interviewing (MI) as an adjunct to CBT. Patients aged 6 to 17 years who were participating in intensive family-based CBT for OCD were randomized to receive either CBT plus MI or CBT plus extra psychoeducation (PE) sessions. After four sessions, the mean Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) score for the CBT plus MI group was significantly lower than for the CBT plus psychoeducation group, t(14) = 2.51, p < .03, Cohen's d = 1.34. In addition, the degree of reduction in CY-BOCS scores was significantly greater, t(14) = 2.14, p = .05, Cohen's d = 1.02, for the CBT plus MI group (mean Δ = 16.75, SD = 9.66) than for the CBT plus psychoeducation group (mean Δ = 8.13, SD = 6.01). This effect decreased over time, and scores at posttreatment were not significantly different. However, participants in the MI group completed treatment on average three sessions earlier than those in the psychoeducation group, providing support for the utility of MI in facilitating rapid improvement and minimizing the burden of treatment for families.     

Changes in need satisfaction and motivation orientation as predictors of psychological and behavioural outcomes in exercise referral

Employing Self-Determination Theory (Deci & Ryan, 1985) as a theoretical framework, this study examined psychological need satisfaction and motivational regulations as predictors of psychological and behavioural outcomes in exercise referral (ER). ER patients (N?=?293; mean age 54.49) completed the measures of motivational regulations, psychological need satisfaction, health-related quality of life, life satisfaction, anxiety, depression and physical activity at entry, exit and 6 months following the end of a supervised exercise programme. Change in (Δ) intrinsic motivation during the scheme significantly predicted adherence and Δ habitual physical activity. Δ psychological need satisfaction from entry to exit significantly predicted Δ habitual physical activity from exit to 6-month follow-up. Δ psychological need satisfaction significantly predicted Δ motivational regulation and Δ psychological outcomes. Contrary to expectations, Δ self-determined regulation did not significantly predict Δ psychological outcomes during the structured part of the scheme, however, it did significantly predict Δ in psychological outcomes from exit to 6-month follow-up. These findings expand on cross-sectional research to demonstrate that psychological need satisfaction during supervised ER longitudinally predicts motivational regulation and psychological outcomes up to 6 months after a structured programme.     

Avatar-based therapy within prison settings: pilot evaluation

The paper presents an introduction of a newly developed, avatar-based virtual reality therapy, as an addition to the therapeutic programme, within a therapeutic community prison in the UK. The participants had six group sessions facilitated by a counsellor. The aim of the project was to investigate whether this approach would improve mental health outcomes for the prisoners, interpersonal relationships within the prison and facilitate the achievement of personal goals for the prisoners. The sample size (n?=?4) was insufficient to make firm conclusions about the mental health outcomes. However, the qualitative analysis showed a strong engagement with the programme in addressing personal issues, the development of insight and empathy, and improvements in relationships within the participants and with the counsellor. Further research with a larger sample is needed to establish efficacy of this type of therapy with the prison population.     

Changes in need satisfaction and motivation orientation as predictors of psychological and behavioural outcomes in exercise referral

Employing Self-Determination Theory (Deci & Ryan, 1985) as a theoretical framework, this study examined psychological need satisfaction and motivational regulations as predictors of psychological and behavioural outcomes in exercise referral (ER). ER patients (N?=?293; mean age 54.49) completed the measures of motivational regulations, psychological need satisfaction, health-related quality of life, life satisfaction, anxiety, depression and physical activity at entry, exit and 6 months following the end of a supervised exercise programme. Change in (Δ) intrinsic motivation during the scheme significantly predicted adherence and Δ habitual physical activity. Δ psychological need satisfaction from entry to exit significantly predicted Δ habitual physical activity from exit to 6-month follow-up. Δ psychological need satisfaction significantly predicted Δ motivational regulation and Δ psychological outcomes. Contrary to expectations, Δ self-determined regulation did not significantly predict Δ psychological outcomes during the structured part of the scheme, however, it did significantly predict Δ in psychological outcomes from exit to 6-month follow-up. These findings expand on cross-sectional research to demonstrate that psychological need satisfaction during supervised ER longitudinally predicts motivational regulation and psychological outcomes up to 6 months after a structured programme.     

Intrinsic goals for leisure-time physical activity predict children's daily step counts through autonomous motivation

ObjectivesThe present study tested a motivational sequence in which children's goals for leisure-time sport and physical activity (PA) from Goal Content Theory predicted pedometer-determined PA through behavioural regulation constructs from Self-Determination Theory.DesignQuantitative cross-sectional study.MethodsA sample of 1272 Flemish (Dutch speaking part of Belgium) sixth graders (M age = 11.42 years) filled in a questionnaire on PA goal content, behavioural regulations and pubertal status. Children's height and weight were measured to assess Body Mass Index (BMI). To measure daily PA behaviour, participants wore a pedometer for seven consecutive days. Structural equation modelling was performed to test the proposed motivational sequence and to examine the mediation effect of behavioural regulations towards leisure-time sport and PA on the relation between PA goal content and daily step counts.ResultsA structural equation model supported the hypothesized sequence in which intrinsic goals for leisure-time sport and PA predicted children's daily step counts through autonomous motivation towards leisure-time sport and PA. Multi-sample invariance testing revealed that the proposed model was largely invariant across BMI groups, pubertal status and gender.ConclusionsThe findings highlight the importance of emphasizing intrinsic goals for participation in leisure-time sport and PA in children aged 10–12 years. By stimulating children to participate in PA and sports by referring to intrinsic goals, children are more likely to enjoy PA, which in turn might increase the likelihood of a regular and long-term PA engagement.     

“Weak,Sad, and Lazy Fatties”: Adolescents’ Explicit and Implicit Weight Bias Following Exposure to Weight Loss Reality TV Shows

Weight loss reality TV shows, which portray obese individuals and their struggle to lose weight, are highly popular. However, the shows often contain negative and stereotypical portrayals of obese individuals that can contribute to the formation of weight bias among viewers. In particular, adolescents might be highly susceptible to such portrayals, since physical appearance and body image play an important role during adolescence. In our experimental study, we investigated the priming effects of exposure to weight loss reality TV shows on implicit and explicit attitudes toward obese individuals among 353 adolescents. We exposed a treatment group (n = 173) to video clips of a weight loss reality TV show and a control group (n = 180) to video clips of an information-based TV magazine. Results indicated that for individuals who expressed a fear of being obese, exposure to the weight loss reality TV show reinforced negative explicit attitudes toward obese individuals by activating a perception of weight controllability. Exposure to the weight loss reality TV show also enhanced negative implicit attitudes toward obese individuals among all adolescents, irrespective of their fear of being obese. Altogether, our findings underscore the role of media in perpetuating weight bias.     

Reframing the ordinary: Imagining time as scarce increases well-being

We explored a counterintuitive approach to increasing happiness: Imagining time as scarce. Participants were randomly assigned to try to live this month (LTM) like it was their last in their current city (time scarcity intervention; n = 69) or to keep track of their daily activities (neutral control; n = 70). Each group reported their activities and their psychological need satisfaction (connectedness, competence, and autonomy) weekly for 4 weeks. At baseline, post-intervention, and 2-week follow-up, participants reported their well-being – a composite of life satisfaction, positive emotions, and negative emotions. Participants in the LTM condition increased in well-being over time compared to the control group. Furthermore, mediation analyses indicated that these differences in well-being were explained by greater connectedness, competence, and autonomy. Thus, imagining time as scarce prompted people to seize the moment and extract greater well-being from their lives.     

The Relationship Between Psychological Needs,Self‐Determined Motivation,Exercise Attitudes,and Physical Fitness1

The primary purpose of this study was to examine the relationships between psychological need satisfaction (competence, autonomy, and relatedness), exercise regulations, and motivational consequences proposed by Self‐Determination Theory (SDT; Deci & Ryan, 1985; Ryan & Deci, 2000). The secondary purpose was to explore changes in these constructs over the course of a 12‐week prescribed exercise program. Results indicated competence and autonomy were positively correlated with more self‐determined exercise regulations, which in turn were more positively related to exercise behavior, attitudes, and physical fitness. Multiple regression analyses revealed that exercise behavior mediated the relationship between self‐determined motives and physical fitness, and both identified and intrinsic exercise regulations contributed significantly to the prediction of attitudes. Paired‐sample t tests supported modest to large changes in need satisfaction constructs, as well as identified and intrinsic regulations over the 12‐week exercise program. These results suggest that SDT is a useful framework for studying motivational issues in the exercise domain.     

Adding motivational interviewing to exposure and ritual prevention for obsessive-compulsive disorder: an open pilot trial

Exposure and ritual prevention (EX/RP) is an efficacious treatment for obsessive-compulsive disorder (OCD), but high dropout rates and variable treatment adherence limit its effectiveness. Motivational interviewing (MI) has shown promise as an adjunct to symptom-focused treatments for improving treatment adherence and outcomes. The authors developed a manual integrating MI with EX/RP, consisting of three information-gathering/motivational enhancement sessions and 15 EX/RP sessions with an optional MI module to be used as needed. Six patients with moderate to severe OCD symptoms (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score> or =16) underwent treatment. Five showed a decrease in their baseline Y-BOCS scores and an increase in their quality of life, with three achieving an excellent response (i.e. Y-BOCS< or =12 at Session 18). The authors briefly describe the motivational strategies used in the six cases and suggest that integrating MI with standard EX/RP is a promising method to increase and sustain patient engagement with EX/RP. Challenges in combining these treatments and maintaining the integrity of each as well as limitations of the study are discussed.     

A Test of Self-Determination Theory in the Exercise Domain

In accordance with self-determination theory (SDT; Deci & Ryan, 1985 ), this study examined the relationship between autonomy support, psychological need satisfaction, motivational regulations, and exercise behavior. Participants ( N =369) were recruited from fitness, community, and retail settings. Fulfillment of the 3 basic psychological needs (i.e., competence, autonomy, and relatedness) related to more self-determined motivational regulations. Identified and introjected regulations emerged as positive predictors of strenuous and total exercise behaviors. Competence need satisfaction also predicted directly—and indirectly via identified regulation—strenuous exercise. For participants engaged in organized fitness classes, perceptions of autonomy support provided by exercise class leaders predicted psychological need satisfaction. Furthermore, competence need satisfaction partially mediated the relationship between autonomy support and intrinsic motivation. These findings support SDT in the exercise domain.     

Feasibility of a Self-Determination Theory-based exercise intervention promoting Healthy at Every Size with sedentary overweight women: Project CHANGE

ObjectivesTo examine feasibility, acceptability and preliminary results of a Self-Determination Theory (SDT) -based exercise intervention with a Healthy at Every Size (HAES) orientation for sedentary overweight/obese women.DesignProject CHANGE was an 8-week randomized controlled trial with follow-up at 4-week.MethodTwenty-five sedentary, overweight women (BMI = 25–34.9) were randomized to either the SDT-based intervention with a HAES orientation (S/H) or exercise only (EX) intervention. The S/H group received exercise training and a weekly behavioral intervention while the EX group received only traditional supervised exercise training. Information about acceptability and feasibility was collected from process evaluation (i.e., participants' satisfaction and feedback) and objective data (e.g., retention, attendance, adherence to the PA goal). Assessments of PA participation and physical/psychological variables were obtained at baseline, post-intervention, and 4-week follow-up.ResultsParticipants reported high levels of satisfaction. Participation in the S/H group averaged 95%. Retention was high for both groups (S/H = 83.3% vs. EX = 84.6%), while adherence to the PA goal was better for the S/H group at follow-up (S/H = 60% vs. EX = 36.4%). The S/H intervention also resulted in larger effect sizes for changes in key motivational variables, including self-determination, autonomy, as well as goal-setting, planning and scheduling self-efficacy.ConclusionThe 8-week SDT-based intervention promoting Healthy at Every Size is feasible and acceptable and may result in better exercise adherence and improvements in motivational variables relative to traditional supervised exercise. These results support conducting additional research to determine the efficacy of this approach for promoting PA in sedentary, overweight women.     

Does Motivational Interviewing (MI) Work With Nonaddicted Clients? A Controlled Study Measuring the Effects of a Brief Training in MI on Client Outcomes

This study investigated the relationships between motivational interviewing (MI) and client symptoms, attendance, and satisfaction. Seventy‐nine clients attending a university‐based counseling center were purposefully assigned to treatment or control conditions. Statistical analyses revealed client symptoms in both groups improved. However, clients assigned to treatment conditions attended more sessions and missed fewer sessions than clients in the control group. Implications for using MI and suggestions for additional research are explored within the study.     

Motivational Interviewing Versus Cognitive Behavioral Group Therapy in the Treatment of Problem and Pathological Gambling: A Randomized Controlled Trial

Pathological gambling is a widespread problem with major implications for society and the individual. There are effective treatments, but little is known about the relative effectiveness of different treatments. The aim of this study was to test the effectiveness of motivational interviewing, cognitive behavioral group therapy, and a no-treatment control (wait-list) in the treatment of pathological gambling. This was done in a randomized controlled trial at an outpatient dependency clinic at Karolinska Institute (Stockholm, Sweden). A total of 150 primarily self-recruited patients with current gambling problems or pathological gambling according to an NORC DSM-IV screen for gambling problems were randomized to four individual sessions of motivational interviewing (MI), eight sessions of cognitive behavioral group therapy (CBGT), or a no-treatment wait-list control. Gambling-related measures derived from timeline follow-back as well as general levels of anxiety and depression were administered at baseline, termination, and 6 and 12 months posttermination. Treatment showed superiority in some areas over the no-treatment control in the short term, including the primary outcome measure. No differences were found between MI and CBGT at any point in time. Instead, both MI and CBGT produced significant within-group decreases on most outcome measures up to the 12-month follow-up. Both forms of intervention are promising treatments, but there is room for improvement in terms of both outcome and compliance.     

Youth with Chronic Pain and Postural Orthostatic Tachycardia Syndrome (POTS): Treatment Mediators of Improvement in Functional Disability

Intensive pain rehabilitation programs are effective in increasing functioning for youth with chronic pain (CP). However, the utility of such programs for youth with CP and co-morbid postural orthostatic tachycardia syndrome (POTS) is rarely examined. In addition, studies examining mediators of treatment for CP are sparse. This paper compares treatment outcomes for youth with CP (n?=?117) and youth with CP?+?POTS (n?=?118). Additionally, depression and pain catastrophizing were tested as potential mediators of treatment effects. Significant treatment improvements were found for functional disability, depression, pain catastrophizing, and perceived pain intensity but with no differences between groups. Improvements in depressed mood, pain catastrophizing (helplessness subscale), and pain severity partially mediated functioning improvement. Pain severity was not a significant mediator in the CP?+?POTS group. We concluded that depression and pain catastrophizing, especially the helplessness domain, can impact functioning improvement in adolescents with CP and POTS and are particularly important to target in treatment.     

Predictors of rapid versus thoughtful judgments of meaning in life

As with other measures of subjective well-being, self-reports of meaning in life (MIL) can be influenced by transient, contextual factors. Further, the sources of information used in judging MIL can vary depending on their relevance and cognitive accessibility. This study examined the effects of differing instructions on the sources of information used to judge MIL. Participants (N?=?103) completed measures of positive affect (PA), religious commitment, and the satisfaction of the needs for competency, autonomy, and relatedness and then were randomly assigned to complete a measure of MIL rapidly, thoughtfully, or using typical instructions. Results showed that condition moderated reliance on PA, autonomy and social relatedness need satisfaction: PA was a stronger predictor of MIL in the thoughtful condition while autonomy and relatedness were more strongly related to MIL in the rapid condition. Implications for our understanding of MIL and future directions are discussed.